Occupational and sociodemographic inequalities in fire, heat and hot substance-related injuries among working-age adults: A Global Burden of Disease 2021 analysis.

Abstract

Fire, heat and hot substance-related injuries are a major source of preventable occupational and domestic trauma among working-age adults worldwide. Despite their large economic and social consequences, age-specific and inequality-focused global evidence for adults aged 20-54 years remains limited, particularly in relation to occupational exposure and socioeconomic development. Using Global Burden of Disease 2021 data, we quantified prevalence, mortality, and disability-adjusted life years (DALYs) for adults aged 20-54 years in 204 countries from 1990 to 2021. Age-standardized rates (ASRs), estimated annual percentage changes (EAPCs), and associations with Sociodemographic Index (SDI) were assessed. Deaths and DALYs attributable to high alcohol use and occupational injuries were analyzed. From 1990 to 2021, global ASRs declined for prevalence (EAPC, -1.54; 95% CI, -1.61 to -1.47), mortality (EAPC, -2.02; 95% CI, -2.26 to -1.77), and DALYs (EAPC, -2.01; 95% CI, -2.18 to -1.85). In 2021, prevalence ASR ranged from 769.0 per 100,000 in South Asia to 7498.0 per 100,000 in Southern Latin America; mortality ASR from 0.2 in Australasia and Western Europe to 4.8 in Southern Sub-Saharan Africa; DALY ASR from 34.9 in East Asia to 332.2 in Southern Sub-Saharan Africa. Prevalence was positively associated with SDI, whereas mortality and DALY rates showed inverse associations with SDI. Males aged 35-39 years had higher prevalence; females aged 20-34 years had higher mortality and DALY burdens. Occupational injuries accounted for 24.1% of deaths and 25.1% of DALYs, mainly in low- and middle-income regions; alcohol use contributed more in high-income regions. Although the burden of fire, heat and hot substance-related injuries among adults aged 20-54 years has declined globally, large and preventable inequalities persist. Occupational injuries dominate in industrializing regions, while limitations in burn care systems continue to drive excess mortality and disability in low-SDI settings, indicating the need for region-specific injury prevention and system-level interventions.